<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" name="row[name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Website')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-website" class="form-control" name="row[website]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Provinceid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-provinceId" class="form-control" name="row[provinceId]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Cityid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-cityId" class="form-control" name="row[cityId]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Level')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-level" class="form-control" name="row[level]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Abbreviation')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-abbreviation" class="form-control" name="row[abbreviation]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('City')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-city" class="form-control" data-toggle="city-picker" name="row[city]" type="text"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Logo')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-logo" class="form-control" name="row[logo]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pid" class="form-control" name="row[pid]" type="number">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
